scholarly journals P46 LOW DOSE CYCLOPHOSPHAMIDE AS AN INDUCTION AGENT IN PROLIFERATIVE LUPUS NEPHRITIS PATIENTS IN CENTRAL INDIA - AN AFFORDABLE & VIABLE OPTION

2016 ◽  
Vol 1 (4) ◽  
pp. S21
Author(s):  
M. Balwani ◽  
C. Bawankule ◽  
R. Yadav ◽  
N. Ambade
Keyword(s):  
Lupus Nephritis ◽  
Low Dose ◽  
Central India ◽  
Induction Agent ◽  
Viable Option ◽  
Proliferative Lupus Nephritis

Maintenance Therapies for Proliferative Lupus Nephritis: Mycophenolate Mofetil, Azathioprine and Intravenous Cyclophosphamide

Lupus ◽  
2005 ◽  
Vol 14 (3_suppl) ◽  
pp. 33-38 ◽  
Author(s):  
G Contreras ◽  
E Tozman ◽  
Nilay Nahar ◽  
David Metz
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Treatment Failure ◽  
Low Dose ◽  
Cumulative Probability ◽  
High Dose ◽  
Short Term ◽  
Proliferative Lupus Nephritis ◽  
Severe Infections

For the treatment of proliferative lupus nephritis, long-term cyclophosphamide (CY) regimens are efficacious, however, at the expense of substantial toxicity. In the last decade, sequential regimens of short-term CY induction followed by either mycophenolate mofetil (MMF) or azathioprine (AZA) maintenance have shown to be efficacious and safe reducing the long-term exposure to CY. In a maintenance study including predominantly Hispanics and African-Americans, the patients who received MMF and AZA maintenance had a higher cumulative probability of remaining free of the composite of death or chronic renal failure (CRF) compared to quarterly intravenous CY (IVCY) maintenance (89% in MMF, 80%, in AZA and 45% in IVCY). Likewise, MMF and AZA maintenance were associated with significantly lower incidence of severe infections (2% in each MMF or AZA, and 25% in IVCY), sustained amenorrhea (6% in MMF, 8% in AZA, and 32% in IVCY), and hospitalizations (one hospital-days per patient-year in each MMF or AZA, and 10 in IVCY). In a European induction study including predominantly Caucasians, patients who received any of two sequential regimens, low dose versus high dose IVCY induction both followed by AZA maintenance, had a high cumulative probability of remaining free of treatment failure (84% in low dose IVCY and 80% in high dose IVCY; treatment failure defined as a composite of free of corticosteroid resistant flare, nephrotic syndrome, doubling creatinine, and persistent elevated creatinine). Low dose IVCY and high dose IVCY induction were associated with low incidence of sustained amenorrhea (4% in each group) and severe infections (11% in low dose and 22% in high dose IVCY induction). Of interest, most of the severe infection episodes occurred while patients were receiving IVCY induction. Finally an Asian study demonstrated that patients with proliferative lupus nephritis could be effectively treated with short-term oral CY induction followed by AZA maintenance. The cumulative probability of complete remission was 76%. The relapse rate was only 11%. The incidence of permanent amenorrhea and infection were 8% and 33%, respectively. None of the Asian patients had an increase in serum creatinine level to double the baseline value. Maintenance therapies with MMF or AZA following short-term CY induction in a sequential regimen are efficacious and safe for the treatment of high-risk patients with proliferative lupus nephritis.

Low dose cyclosporine A in the treatment of resistant proliferative lupus nephritis

2017 ◽  
Vol 28 (3) ◽  
pp. 523-529 ◽  
Author(s):  
Marjan Sheikholeslami ◽  
Mehrzad Hajialilo ◽  
Seyed Sadreddin Rasi Hashemi ◽  
Aida Malek Mahdavi ◽  
Morteza Gojazadeh ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Cyclosporine A ◽  
Low Dose ◽  
Proliferative Lupus Nephritis

Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia

Lupus ◽  
2019 ◽  
Vol 28 (9) ◽  
pp. 1082-1090 ◽  
Author(s):  
A H Almalki ◽  
F A Alrowaie ◽  
H M Alhozali ◽  
N K Almalki ◽  
A I Alsubei ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Lupus Erythematosus ◽  
Severe Disease ◽  
Induction Agent ◽  
Renal Survival ◽  
Long Term Outcomes ◽  
Proliferative Lupus Nephritis ◽  
Cumulative Rate

Background Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. Methods An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. Results Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44–29.39, p = 0.015). Based on Kaplan–Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. Conclusion Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.

scholarly journals Addition of cyclosporine/tacrolimus for pediatric relapsed lupus nephritis during mycophenolate mofetil maintenance therapy

2018 ◽  
Vol 47 (1) ◽  
pp. 105-113 ◽  
Author(s):  
Youying Mao ◽  
Lei Yin ◽  
Hua Huang ◽  
Zhengyu Zhou ◽  
Tongxin Chen ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Adverse Effects ◽  
Adverse Events ◽  
Maintenance Therapy ◽  
Clinical Response ◽  
Low Dose ◽  
Good Choice ◽  
Proliferative Lupus Nephritis ◽  
Remission Rates

Objective We aimed to evaluate the efficacy of low-dose cyclosporine (CsA) or tacrolimus (Tac) in children with proliferative lupus nephritis (PLN) during maintenance therapy. Methods A low dose of CsA or Tac was added to 11 children who relapsed during mycophenolate mofetil (MMF) maintenance therapy. Renal remission was analyzed at 3 and 6 months, and at 1, 2, and 3 years after CsA/Tac addition. Adverse effects were recorded. Results The clinical response rates were 81.9%, 100%, 90.0%, 100%, and 100% at 3 months, 6 months, 1 year, 2 years, and 3 years after CsA/Tac addition, respectively. Complete renal remission rates were 45.5%, 45.5%, 40.0%, 44.4%, and 71.4% at 3 months, 6 months, 1 year, 2 years, and 3 years after CsA/Tac addition, respectively. None of the patients had severe adverse events. Conclusion Low-dose CsA/Tac combined with MMF shows a promising effect in renal remission with acceptable safety in children with PLN. Therefore, this combination would be a good choice for children with lupus nephritis who relapse or have suboptimal MMF maintenance therapy.

Sign in / Sign up

Export Citation Format

Share Document